Former DOJ Officials Warn of ‘Big Health Care’ Monopolies

In a recent JAMA opinion piece, Martin Gaynor, PhD, and Jonathan Kanter, JD — both former officials of the U.S. Department of Justice’s Antitrust Division — highlight the emergence of expansive health care conglomerates that mirror the monopolistic tendencies of “Big Tech.”

These entities — the authors cite companies including UnitedHealth Group and CVS Health as examples — have evolved into vertically integrated platforms encompassing insurance, pharmacy benefit management, physician services and data analytics. This “platformization” of health care raises concerns about diminished competition and increased barriers for independent practitioners.

“The largest U.S. health care companies are no longer just health insurers, pharmacy benefit managers, physician practices, home health agencies, hospices, data warehouses, data analytics firms, or hospitals; increasingly, they are all of the above,” explains Gaynor, a professor of economics and public policy at Carnegie Mellon’s Heinz College.

“We are at an inflection point,” Kanter adds. “The trends we see are undermining the ability of health care markets to function adequately, making the U.S. health care system even more expensive, unresponsive, and inaccessible.”

Consolidation’s impact on independent practices
The consolidation trend has significant implications for independent physicians and smaller practices. Studies indicate that mergers and acquisitions in the health sector often lead to higher costs without corresponding improvements in care quality.

For instance, a study published in the Journal of the American College of Surgeons found little evidence that hospital mergers reduce costs or improve care quality.

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